ABSTRACT
The increased longevity due to advances in health care has resulted in an increased diagnosis of aortic valve disease in the elderly. The prevalence of both, aortic stenosis (AS) and aortic regurgitation (AR), increases with age. The evaluation and management of an elderly patient with aortic valve disease includes full assessment of other medical comorbidities (which are frequently present in this population) and functional frailty, as these variables affect the treatment outcomes. AS and chronic AR are well tolerated for many years; however the prognosis becomes very poor once the symptoms appear. Therefore, careful assessment and follow-up arenecessary. Several characteristic findings on physical exam can help in the initial diagnosis of aortic valve disease and provide an idea of its severity. Echocardiography is the primary imaging tool to diagnose and assess severity of aortic valve diseases. Historically, surgical aortic valve replacement (AVR) has been the treatment of choice in patients requiring invasive treatment for aortic valve diseases. However, a significant proportion of elderly patients were either not referred, were inoperable, or were at highrisk for surgical AVR due to their comorbidities. Advancements in minimally invasive surgical and transcatheter aortic valve replacement (TAVR) treatment options have provided an alternative for elderly patients who are otherwise inoperable or high-risk candidates for open heart AVR surgery. In this chapter we discuss the etiology, prevalence, diagnosis, and treatment options for aortic stenosis and aortic regurgitations in elderly patients.
